Medical Staff Bulletin

September 2018

In this issue:

• Connecting global health efforts with local healthcare challenges
• Patient Safety and Quality Metrics
• Training to begin for Epic upgrades
• Clinical Redesign: MRSA Optimization
• Clinical Redesign Team Hackathon: October 19-20
• Flu vaccination fairs begin this month
• HRO training schedule for newly credentialed practitioners
• Newsmakers
• Upcoming Events
• Request for patient stories

Connecting global health efforts with local healthcare challenges

A message from Thomas Balcezak, MD, Chief Medical Officer

I usually devote these messages to highlight the work we do to improve care for patients. One of the wonderful things about having a large, committed medical staff filled with master clinicians, teachers, international experts and leaders in research, however, is that our organization has deep and productive relationships with people and institutions all over the world. Those relationships have allowed members of our medical staff to share their prodigious skills to positively impact the lives of people living in settings where healthcare systems function far differently than they do in our part of New England.

I feel strongly that participating in effective, sustainable and ethical international health work is essential to fulfilling our mission to enhance the lives of the patients we serve. We live in an increasingly interconnected world, and we are obligated to participate in that global community in the hope that our participation will positively impact people whose lives and events will at some point inevitably impact our own. A common criticism of global health engagement is that it comes at the expense of local service. However, much recent commentary, including some written by members of our medical staff, has helped to show how engagement in thoughtful global health efforts can help us learn and make thoughtful changes to address the significant healthcare challenges we face locally. 

There are many existing wonderful examples of efforts where our clinicians lead and participate in ethically designed, sustainable international health programs that positively impact international communities while expanding the understanding of our physicians into the impact of geographic, ethnocultural and socioeconomic diversity on a community's health. For example, under the guidance of Drs. Asghar Rastegar and Tracy Rabin, hundreds of medicine and emergency medicine trainees have participated in global health work at sites in Uganda, Liberia and South Africa. Dr. Michael Dewar in Cardiac Surgery has run an education program in St. Petersburg, Russia, for more than two decades. Many other members of the medical staff have longstanding relationships with other high-quality international health programs.

We will continue to foster these activities and make it easier for more of our trainees and members of the medical staff to participate in international health initiatives that are designed ethically, sustainably, and in a way that generates equitable benefits for those from Yale New Haven and the patients and local healthcare providers collaborating with us. We must at all costs avoid situations where members of our medical staff participate in medical tourism, where the activity does not materially benefit, or worse, harms patients overseas.

To that end, we are organizing a YNHH Center for International Medicine that will provide a centralized structure to vet new programs against a battery of factors. This will ensure patient safety and benefit, facilitate and track completion of the appropriate certifications that may be required of our medical staff, act as a resource to match clinicians with programs, and, as indicated, various funding sources, all in hopes of increasing the ease and amount of participation of our practitioners in these programs.

Those that have had the privilege of participating in global health work, myself included, often speak about how their experiences gave them new perspective, deepened their respect for people and practitioners living and working in resource-poor settings, and nudged them to break out of professional ruts that can form after practicing in the U.S. healthcare system. I hope our work to develop a more structured approach to hospital-facilitated and supported global health efforts will increase the number of our trainees and staff to develop similarly an appreciation and connection to people across the globe, in hopes that it will drive innovation to serve those communities and our own in Connecticut.

As always, I welcome your questions and feedback, and can be reached via email at [email protected]

Patient Safety and Quality Metrics

The Patient Safety and Quality metrics are reported on a 12-month rolling timeframe. The most recent timeframes differ based upon the various databases reporting the metrics. 12-month rolling total updated with AHRQ v6.0 definition starting January 2017.

Patient Safety and Quality Metric Definitions

Colon and Hysterectomy SSI: A surgical site infection within 30 days of the operative procedure, classified as superficial, deep, or organ/space infections based on CDC/NHSN surveillance definitions.

C. diff (Clostridium difficile): A patient who develops diarrhea greater than 48 hours after admission to an inpatient unit and for whom the C. diff testing (either rapid toxin, cytotoxin or PCR) is positive.

CAUTI (Catheter Associated Urinary Tract Infection): A patient who has an indwelling urinary catheter in place for over two days, with at least one of the following signs or symptoms: fever > 38○ C, suprapubic tenderness (with no other recognized cause), costovertebral angle pain/tenderness (with no other recognized cause), urinary urgency (not while catheter in place), urinary frequency (not while catheter in place), or dysuria (not while catheter in place).

CLABSI (Central Line Associated Blood Stream Infection): A primary bloodstream infection (not related to an infection at another site) that develops in a patient with a central line in place over two days before onset of the infection. Culturing the catheter tip is not a criterion for a CLABSI.

Iatrogenic Pneumothorax: A pneumothorax caused by medical care, with certain exclusions for trauma, cardiac and thoracic surgery patients.

PE/DVT (Pulmonary Embolism/Deep Vein Thrombosis): Any PE/DVT that occurs postoperatively.

Serious Safety Event: A deviation from generally expected care that results in moderate to severe patient harm.

 

Training to begin for Epic upgrades

On October 21, Yale New Haven Health System will upgrade Epic to the newest release (2018). This means there will be a number of changes, most of which will be minor and intuitive, but some of which will change the look and feel of activities that you currently perform in the system.

Changes will occur in all of the areas that Epic is used: ambulatory, inpatient, ED and the practice specific modules such as Stork (OB) and Surgery (Optesia).

Although the team will reach out prior to the go-live to do demonstrations and education via staff meetings and other live gatherings, we recognize that not all providers can attend these meetings.  Members of the IT staff will provide on-site support during the week after this go live. We also are working to develop super users to support fellow clinicians. 

However, the primary tool for education will be e-learning materials that will be posted to the new YNHHS and School of Medicine education site after September 10.  We will post links to the educational material via the Epic splash screen and e-mail messaging.

It is strongly recommended that practitioners who use Epic review the training material that includes short training films and tip sheets prior to the October 21 go-live. Each training module is divided into what we perceive will be the critical items that represent the largest change and those that are "nice-to-know."  While most changes will be enhancements, relatively intuitive and not cause practitioners significant difficulties, a few changes may prove difficult on day one if you have not reviewed the e-learning.

Clinical Redesign: MRSA Optimization

Looking at patient readmissions, the Emergency Department questioned if there was opportunity to assess the necessity of isolation for patients with MRSA upon subsequent admission.

A Clinical Redesign team formed to focus on identifying MRSA patients earlier and appropriately upon arrival for treatment within the ED. "We were seeing a large number of patients still on contact precautions without re-testing for continued presence of MRSA," said Crystal Clemons, consultant with the Office of Strategy Management at YNHHS. "We enlisted the help of Joint Data Analytics Team and Infection Prevention team to analyze the records of patients identified with MRSA back to 2008. We were then able to use an Epic utility that removed the isolation precaution from eligible patients' medical records."

The team focused on the following interventions to:

• Develop reports to identify the MRSA isolation population
• Implement new criteria/policy for MRSA testing
• Implement 24/7 ability to remove contact precautions
• Implement Epic utility
• Implement use of rapid MRSA testing
• Create a best practice alert for remaining MRSA isolation patients within the ED upon inpatient admission

"The best practice alert encourages providers to order the rapid MRSA test to assist with proper contact precaution status and bed placement," Clemons said.

The results were telling. Prior to the Epic utility, there were more than 17,000 patients with a MRSA isolation reason attached to their medical record. The new reports identified over 8,000 patients who no longer met criteria for MRSA isolation and were removed.

Through specific interventions, the team reduced the number of patients with MRSA isolations, which enhanced the ability for more accurate medical records. "The rapid MRSA test also improved the ED length of stay and appropriate bed placement," Clemons said.

 

Clinical Redesign Team Hackathon: October 19-20

Spend the day "hacking" away at the Clinical Redesign Team Hackathon, October 19-20 at 55 Park St., New Haven.  Get ready for hours of competition, working together to create novel projects and innovative solutions to around-the-clock precision care.

No experience is required. The hackathon is open to Yale New Haven Health employees across the system, Yale School of Medicine and Yale Medicine. The event's organizers are looking for clinical and non-clinical participants to help form diverse groups that will encourage new ideas. If interested, apply online at CRHackathon.org or email [email protected].

 

Flu vaccination fairs begin this month

Flu vaccination at Yale New Haven Hospital and throughout YNHHS is again mandatory. All physicians and employees must receive a flu vaccination or have an approved medical or religious exemption by December 1, 2018. This includes members of the YNHH medical staff, as well as employed and community physicians affiliated through NEMG and Yale Medical Group. Requests for medical or religious exemptions submitted by September 30 will be accepted or denied by October 31.

Members of the medical staff can receive the flu vaccine at no cost, at flu clinics throughout the hospital campuses this fall. They may also get vaccinated elsewhere and should provide documentation of the vaccination. Refer to the list below for upcoming flu vaccination fairs available at YNHH's York Street and Saint Raphael campuses.

 

York Street Campus, East Pavilion Cafeteria Special Events Area

Oct. 17, 18, 19, 20 and 21: 7 am - 7 pm
Oct. 22, 23, 24 and 25: 7:30 am - 3 am (the following day)
Oct. 26, 27, 28 and 29: 7 pm - 7 am (the following day)
Oct. 29: 7 pm - 3 am (the following day)
Oct. 30 and 31: 7:30 am - 3 am (the following day)
Nov. 1, 2 and 3: 7:30 am - 3 am (the following day)
Nov. 4 and 5: 11:45 pm - 8 am
Nov. 6 and 7: 7 am - 6 pm
Nov. 9 and 11: 7 am - 7 pm
Nov. 12: 7 am - 7 pm
Nov. 13 and 16: 7 pm - 3 am (the following day)
Nov. 18: 7 am - 7 pm
Nov. 27 and 28: 5 pm - midnight

Saint Raphael Campus, Fresh Inspirations Cafeteria

Oct. 24, 25, 26, 27, 28, 29 and 30: 7 am - 7 pm
Nov. 7, 8, 9 and 10: 7 am - 7 pm
Nov. 11 and 12: 7 pm – 3 am (the following day)
Nov. 19 and 20: 5 pm - 2 am (the following day)
Nov. 26, 27, 28, 29 and 30: 7 am - 7 pm

 

HRO training schedule for newly credentialed practitioners

High Reliability Organization (HRO) training is required for newly credentialed practitioners across the health system. Medical Staff members can attend training on any of the dates or locations listed below. To register for an upcoming session, please contact [email protected] or [email protected].

*These sessions are modules of the general new employee orientation, but others are welcome to attend as space allows. Note: Bridgeport Hospital currently uses a more comprehensive, 3.5-hour training program. They are in the process of converting to the more streamlined training module used elsewhere.

Newsmakers

The Oct. 2 issue of Circulate features a paper co-authored by Dan Jacoby, MD, director of the Comprehensive Heart Failure Program at Yale New Haven Hospital. This research, the result of international collaboration, provides important new insights into the cumulative disease burden for patients living with HCM and underscores the need for accurate diagnosis, consistent monitoring, and new treatments that target the underlying cause of disease. Read the article in Circulate (https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.033200).

Upcoming Event

Plan to attend the Innovation and Diversity Summit: Patient-Centered Approaches to Care and Research, October 5, 2018, at Yale School of Medicine, Harkness Auditorium, 333 Cedar St., New Haven. The summit is a collaboration of Yale School of Medicine with partners at the FDA Office of Minority Health and the Yale Center for Clinical Investigation (YCCI) Cultural Ambassadors for Clinical Research. It will focus on raising awareness about the need for minorities and subpopulation participation in clinical trials; patient-centered approaches to care and research; and the role of technology in both areas. The goal is to bring stakeholders from governmental agencies, industry, academia and community to provoke discussion about innovation and clinical trial diversity.  The event will feature Yale CTSA work and presentations from the FDA and the Henrietta Lacks Family. 

The annual Advanced Practice Providers Awards Dinner will be October 23 at 5 pm, Anthony's Ocean View, New Haven. The well-received event recognizes the tremendous value and impact that APPs have throughout YNHH.

Request for patient stories

Yale New Haven Health often features patient stories to highlight the work and dedication of our physicians, nurses and staff in its print publications, websites and advertising campaigns. If you have a patient that you think would make a great story -- and who is willing to share his or her experience -- please contact Cynthia Whitcomb at 203-688-9440, [email protected].